scholarly journals New coronavirus infection in children in the Moscow region: clinical, epidemiological and treatment aspects

2020 ◽  
Vol 49 ◽  
Author(s):  
E. R. Meskina ◽  
M. K. Khadisova ◽  
T. V. Stashko ◽  
A. V. Bitsueva
Keyword(s):  
Pediatric Patients ◽  
Respiratory Infections ◽  
Severe Disease ◽  
Age Distribution ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Generation Cephalosporin ◽  
Moscow Region ◽  
Epidemiological Characteristics

Aim: To assess clinical and epidemiological characteristics, as well as treatment results in COVID-19 pediatric patients hospitalized to the Department of infectious disease in the Moscow region.Materials and methods: We retrospectively analyzed medical records of 124 pediatric patients aged from 1 month to 17 years with confirmed (63.7%) and highly probable (proven epidemiological association with the infection source) COVID-19 infection. The children were hospitalized from March 25, 2020 to August 11, 2020. Among patients that were hospitalized during this time period, 43% had pneumonia and 30% had acute respiratory disorders. All cases of pneumonia were confirmed by computed tomography. The children were treated according to the standard Russian guidelines.Results: The children had been infected with SARS-CoV-2 mostly from family members (75%; 95% confidence interval (CI) 66.4–82.3). In the families of the children with pneumonia, the number of pneumonia cases in their relatives was higher than in the families of the children with acute respiratory infections (1.7±1.0 vs. 1.1±0.5 respectively; р<0.001). The mean age of the hospitalized children was 8 years (7.4–9.6), with an even age distribution. The main COVID-19 signs and symptoms were as follows: fever (75.8%; 95% CI 67.3–83.0), cough (66.1%; 95% CI 57.1–74.4]), fatigues (38.7%; 95% CI 30.1–47.9), and hyposmia (33.9%; 95% CI 25.6–42.9). The severe disease course was rare (2.4%; 95% CI 0.5–6.9). The rates of positive reverse transcriptase polymerase chain reaction tests for SARS-CoV-2 were rapidly decreased at repeated tests: at day 3, 63.7% of the tests were positive, at day 7, 21.8% and at day 14, 5.6% (р<0.001). The prevalence of pneumonia was 56.4% without any age differences, with mostly minimal areas of lung abnormalities (78.6%). The severity of pneumonia and duration of clinical manifestations in the patients treated with a III generation cephalosporin or its combination with a macrolide were similar. Cough duration in those, who were treated with ipratropium bromide /fenoterol inhalations including their combination with budesonide, was higher than in those who did not use inhalation treatment. Pyrexia of>5 days duration can be a predictor of pneumonia in a  pediatric patient with COVID-19 (odds ratio 4.55 (2.1–9.9), sensitivity 61.4%, specificity 74.1%).Conclusion: The results obtained are important to develop further treatment strategies for children with COVID-19.

scholarly journals Epidemiological and Clinical Characteristics of Children with Coronavirus Disease 2019

2020 ◽  
Author(s):  
Qin Wu ◽  
Yuhan Xing ◽  
Lei Shi ◽  
Wenjie Li ◽  
Yang Gao ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Clinical Manifestations ◽  
Epidemiological Data ◽  
Good Prognosis ◽  
Pcr Analysis ◽  
Respiratory Pathogens ◽  
Upper Respiratory Tract ◽  
Radiologic Findings ◽  
Epidemiological Characteristics

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified pathogen which mainly spreads by droplets. Most published studies focused on adult patients with coronavirus disease 2019 (COVID-19), but data concerning pediatric patients is limited. This study aimed to determine epidemiological characteristics and clinical features of pediatric patients with COVID-19.MethodsWe reviewed and analyzed data on pediatric patients with laboratory-confirmed COVID-19, including basic information, epidemiological history, clinical manifestations, laboratory and radiologic findings, treatment, outcome and follow-up results.ResultsFrom January 20th to February 27th of 2020, a total of 74 pediatric patients with COVID-19 were included in this study. Of the 68 cases whose epidemiological data were complete, 65 (65/68, 95.59%) cases were household contacts of adults whose symptoms developed earlier. Forty (59.46%) of the infected children were male, and the median age and body weight are 6 (0.10-15.08) years and 24 (4.20-87.00) kg, respectively. Except for one critically ill case, 20 (27.03%) patients did not show any symptoms of infection, 24 (32.43%) patients had acute upper respiratory tract infection and 29 (39.19%) patients were diagnosed with mild pneumonia. Cough (24/74, 32.43%) and fever (20, 27.03%) were the predominant symptoms of 44 (59.46%) symptomatic patients at onset of the illness. Abnormalities in leukocyte count were found in 23 (31.08%) children and 10 (13.51%) children presented with abnormal lymphocyte count. Of the 34 (45.95%) patients who had nucleic acid testing results for common respiratory pathogens, 19 (19 / 34, 51.35%) showed co-infection with other pathogens other than SARS-CoV-2.Ten (13.51%) children had RT-PCR analysis of SARS-CoV-2 for fecal specimens and 8 of them showed prolonged existence of SARS-CoV-2 RNA 11 (5-23) days after nasopharynx swabs turning negative. Abnormalities in chest imaging were observed in 37 (50.00%) patients and 28 (37.84%) of them only presented with nontypical changes.All children had good prognosis with a median hospitalization duration of 11 days and follow-up period of 16.5 days. During the follow-up period, all the patients remained in quarantine at designated site and home for two 14-day obervation periods and showed no clinical manifestation,but 3 of the 8 cases with prolonged fecal shedding of SARS-CoV-2 still showed positive result of feces test.

scholarly journals Management and Clinical Characteristics in Children with SARS-CoV-2 Infection: Experience in a highly complex public hospital in the city of São Paulo

2020 ◽  
Author(s):  
Rafael Santos Rodrigues Vieira ◽  
Erisson Linhares de Aguiar ◽  
Nara Michelle de Araújo Evangelista ◽  
Sergio Antonio Bastos Sarrubbo ◽  
Helmar Abreu Rocha Verlangieri ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Pediatric Patients ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Sao Paulo ◽  
World Health ◽  
São Paulo ◽  
Pediatric Hospital ◽  
Multiprofessional Team ◽  
The City

AbstractIn February 2020, the World Health Organization designated the disease COVID-19, which means Coronavirus disease 2019. The virus that causes COVID-19 is designated as severe acute respiratory syndrome by Coronavirus 2 (SARS-CoV-2). The virus tends to determine clinical manifestations more frequently in adults and, especially, in the elderly, with high mortality in the population with chronic diseases. Most studies confirm the trend towards less severe disease in pediatric patients, and few studies describe the behavior of the virus in children. In late February 2020, a public pediatric hospital in the city of São Paulo, in the face of the announced epidemic, through its multiprofessional team, prepared itself to the care of patients with SARS-CoV-2 infection, determing certain clinical protocols defining the flow of care and therapeutic procedures to patients. This study intends to present the clinical characteristics and evolution of the disease by SARS-CoV-2 in pediatric patients seen in a public pediatric hospital of high complexity, evaluating the effectiveness and acceptance of the measures adopted. As a result, a good evolution of the disease was observed in the affected children, even in those with comorbidities. There was a trend towards a greater number of days of hospitalization and the need for ICU in patients with comorbidities and progression with clinical worsening after initial improvement. The protocols adopted and the flow instituted allowed good adherence by the multidisciplinary team.

scholarly journals Surveillance of endemic human coronaviruses (HCoV-NL63, OC43 and 229E) associated with pneumonia in Kilifi, Kenya

2020 ◽  
Vol 5 ◽  
pp. 150
Author(s):  
Grieven P. Otieno ◽  
Nickson Murunga ◽  
Charles N. Agoti ◽  
Katherine E. Gallagher ◽  
Juliet O. Awori ◽  
...  
Keyword(s):  
Respiratory Virus ◽  
Seasonal Pattern ◽  
Severe Disease ◽  
Age Distribution ◽  
Coastal Region ◽  
Severe Pneumonia ◽  
Human Populations ◽  
Surveillance Period ◽  
Human Coronaviruses ◽  
Epidemiological Characteristics

Introduction: Human coronaviruses (HCoVs) circulate endemically in human populations, often with seasonal variation. We describe the long-term patterns of paediatric disease associated with three of these viruses, HCoV-NL63, OC43 and 229E, in coastal Kenya. Methods: Continuous surveillance of pneumonia admissions was conducted at the Kilifi county hospital (KCH) located in the northern coastal region of Kenya. Children aged <5 years admitted to KCH with clinically defined syndromic severe or very severe pneumonia were recruited. Respiratory samples were taken and tested for 15 virus targets, using real-time polymerase chain reaction. Unadjusted odds ratios were used to estimate the association between demographic and clinical characteristics and HCoV positivity. Results: From 2007 to 2019, we observed 11,445 pneumonia admissions, of which 314 (3.9%) tested positive for at least one HCoV type. There were 129 (41.1%) OC43, 99 (31.5%) 229E, 74 (23.6%) NL63 positive cases and 12 (3.8%) cases of HCoV to HCoV coinfection.  Among HCoV positive cases, 47% (n=147) were coinfected with other respiratory virus pathogens. The majority of HCoV cases were among children aged <1 year (66%, n=208), though there was no age-dependence in the proportion testing positive. HCoV-OC43 was predominant of the three HCoV types throughout the surveillance period. Evidence for seasonality was not identified. Conclusions: Overall, 4% of paediatric pneumonia admissions were associated with three endemic HCoVs, with a high proportion of cases co-occurring with another respiratory virus, with no clear seasonal pattern, and with the age-distribution of cases following that of pneumonia admissions (i.e. highest in infants). These observations suggest, at most, a small severe disease contribution of endemic HCoVs in this tropical setting and offer insight into the potential future burden and epidemiological characteristics of SARS-CoV-2.

scholarly journals Children’s Interstitial and Diffuse Lung Diseases (ChILD) in 2020

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 280
Author(s):  
Valentina Agnese Ferraro ◽  
Stefania Zanconato ◽  
Andrea Zamunaro ◽  
Silvia Carraro
Keyword(s):  
Lung Diseases ◽  
Developmental Disorders ◽  
Respiratory Infections ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Surfactant Protein ◽  
Exercise Intolerance ◽  
Patient Treatment ◽  
High Resolution Computed Tomography ◽  
Cell Hyperplasia

The term children interstitial lung diseases (chILD) refers to a heterogeneous group of rare diseases that diffusely affect the lung. ChILD specific to children younger than 2 years of age include diffuse developmental disorders, growth abnormalities, specific conditions of undefined etiology (neuroendocrine cell hyperplasia of infancy and pulmonary interstitial glycogenosis) and surfactant protein disorders. Clinical manifestations are highly variable, ranging from the absence of relevant symptoms to a severe onset. Most commonly, chILD presents with nonspecific respiratory signs and symptoms, such as dyspnea, polypnea, dry cough, wheezing, recurrent respiratory infections and exercise intolerance. In the diagnostic approach to a child with suspected ILD, chest high resolution computed tomography and genetic tests play a central role. Then, if the diagnosis remains uncertain, laryngotracheal-bronchoscopy and lung biopsy are needed. Pharmacological treatment is mostly empiric and based on anti-inflammatory and immunomodulatory drugs including corticosteroids, hydroxychloroquine and azithromycin. Despite chILD overall rarity, pediatric pulmonologists must be familiar with these diseases in order to carry out a timely diagnosis and patient treatment.

Pyogenic Arthritis of the Sacroiliac Joint in Pediatric Patients

PEDIATRICS ◽  
1980 ◽  
Vol 66 (3) ◽  
pp. 375-379
Author(s):  
Urs B. Schaad ◽  
George H. McCracken ◽  
John D. Nelson
Keyword(s):  
Pediatric Patients ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Etiologic Agent ◽  
Cast Immobilization ◽  
Radiographic Findings ◽  
Pyogenic Sacroiliitis ◽  
Bone Scans ◽  
Adequate Management

Clinical manifestations, diagnostic studies, and management of pyogenic sacroiliitis were reviewed in 77 pediatric patients. This infection occurs primarily in late childhood, is more common in boys, and has a subacute onset in about two thirds of cases. Recognition of the characteristic signs and symptoms of sacroiliac involvement coupled with radioisotope bone scanning substantially reduces the delay in correct diagnosis that averaged 3.9 weeks in all patients (4.8 weeks in those without and 1.7 weeks in those with bone scans performed). Joint aspiration under biplane fluoroscopic control and culture of the aspirated material is indicated in establishing the specific etiologic agent which is Staphylococcus aureus in most cases. Adequate management of pyogenic sacroiliitis consists of appropriately monitored antibiotic treatment and, if present, evacuation of pus. The use of spica cast immobilization offers no apparent beneficial effect. Indications for surgery include drainage of pus and removal of sequestered bone. With adequate management the prognosis of suppurative sacroiliitis in pediatric patients is excellent, despite persistent abnormal radiographic findings in most patients.

Características clínicas y epidemiológicas de pacientes pediátricos con fibrosis quística en Panamá, de Enero 2008 a Diciembre 2017

2020 ◽  
pp. 4-12
Author(s):  
Ana Karina Coronado ◽  
Ricardo A Chanis ◽  
Luis Coronado
Keyword(s):  
Cystic Fibrosis ◽  
Respiratory Infections ◽  
Genetic Defect ◽  
Clinical Manifestations ◽  
Case Fatality ◽  
Failure To Thrive ◽  
City Hospital ◽  
Age Of Diagnosis ◽  
First Year Of Life ◽  
Epidemiological Characteristics

Introducción.La presente investigación plantea como objetivo principal, describir las características clínicas y epidemiológicas de la fibrosis quística (FQ) en Panamá, que nos permiten hacer el diagnóstico temprano y dar a conocer las características bioquímicas, fenotípicas y morbilidades asociadas para así poder mejorar las necesidades de los pacientes con esta enfermedad. Materiales y métodos. Se realizó un estudio retrospectivo de los pacientes con diagnóstico de fibrosis quística entre el mes de enero 2008 a diciembre 2017, en los hospitales en Ciudad de Panamá: Hospital del Niño Dr. José Renán Esquivel, Hospital de Especialidades Pediátricas y en Chiriquí Hospital José Domingo de Obaldía previa aprobación de las autoridades correspondientes.Se analizaron las características demográficas, fenotípicas, resultados bioquímicos, complicaciones y tratamiento de pacientes con diagnóstico de Fibrosis quística. Mediante un diseño descriptivo, se analizó la información de las mismas.Resultados.El promedio de edad para el diagnóstico de fibrosis quística fue de 2.8 años. El 52% correspondía a sexo masculino y 48% a sexo femenino. El promedio de hospitalización previo al diagnóstico de Fibrosis quística fue de 3.8. En el 72 % de los pacientes los primeros síntomas aparecieron antes del primer año de vida.En la mayoría de los pacientes las manifestaciones clínicas fueron una combinación de síntomas gastrointestinales y/o nutricionales y respiratorios (96 y 92% respectivamente).En el 44% de los pacientes se realizó examen genético molecular. De acuerdo con la clasificación del defecto genético, el 20 % de los pacientes eran del grupo delta F 508. La edad promedio de sobrevida es 8.2, años. Durante el período 2008-2017 se registraron 6 defunciones de pacientes con fibrosis quística, lo que corresponde a una tasa de letalidad del 22%.Conclusiones.Los resultados de nuestro estudio mostraron condiciones tales como falla de medro, infecciones respiratorias recurrentes, esteatorrea como la forma de presentación clínica más frecuente. Encontramos correlación con la literatura con la presencia de manifestaciones respiratorias asociadas a compromiso nutricional. El genotipo no se hace a todos los pacientes, reconociendo la importancia de esta valoración por la disponibilidad y costos de las pruebas genéticas. A pesar del diagnóstico temprano, nuestros pacientes cursan con compromiso nutricional importante. En los últimos años se ha evidenciado una media de edad de diagnóstico más temprana comparada con años anteriores. Es necesaria la estandarización de pruebas diagnósticas y de seguimiento, puesto que no todos los pacientes cumplen en su totalidad con los criterios diagnósticos. En la actualidad, un alto índice de sospecha clínica es obligatorio para su detección e intervención inmediata del tratamiento hasta actualización de las instalaciones de diagnóstico. Abstract Introduction .The main objective of the present investigation is to describe the clinical and epidemiological characteristics of cystic fibrosis (CF) in Panama, which allow us to make a nearly diagnosis and make known the biochemical, phenotypic and associated morbidities in order to improve the needs of the patients with this disease. Materials and methodsA retrospective study of patients diagnosed with cystic fibrosis was conducted between January 2008 and December 2017, in hospitals in Panama City: Hospital del Niño Dr. José Renán Esquivel, Hospital de Especialidades Pediátricas Omar Torrijos Herrera and Hospital José Domingo de Obaldía, upon approval of the corresponding authorities. We analyzed the demographic, phenotypic characteristics, biochemical results, complications and treatment of patients diagnosed with Cystic Fibrosis. Through a descriptive design, the information of them was analyzed. Results. The average age for the diagnosis of cystic fibrosis was of 2.8 years, 52% corresponded tomale and 48% female. The average number of hospitalizations prior tothe diagnosis of cystic fibrosis was 3.8. In 72% of the patients the first symptoms appeared before the first year of life. In the majority of patients, the clinical manifestations were a combination of gastrointestinal and / or nutritional and respiratory symptoms (96 and 92% respectively). Molecular genetics examination was performed in 44% of the patients. According to the classification of the genetic defect, 20% of the patients were from the delta F 508 group. The average age of survival is 8.2 years. During the period 2008-2017 there were 6 deaths of patients with cystic fibrosis, which corresponds to a case-fatality rate of 22%.Conclusions.The results of our study showed conditions such as failure to thrive, recurrent respiratory infections, steatorrhea as the most frequent form of clinical presentation. We found correlation with the literature with the presence of respiratory manifestation associated with nutritional compromise. The genotype is not made to all patients, recognizing the importance of assessing the availability and costs of genetictesting. Despite early diagnosis, our patients have an important nutritional commitment. In recenty ears there is evidence of a lower age of diagnosis earlier compared with previous years.It is necessary to standardize diagnostic tests and follow-up, since not all patients fully meet the diagnostic criteria. At present, a high index of clinical suspicion is mandatory for early detection and immediate intervention of the treatment until updating of the diagnostic facilities.  

Clinical Characteristics of Pediatric Patients with Ocular Toxocariasis in China

2016 ◽  
Vol 235 (2) ◽  
pp. 97-105 ◽  
Author(s):  
Yalu Liu ◽  
Qi Zhang ◽  
Jing Li ◽  
Xunda Ji ◽  
Yu Xu ◽  
...  
Keyword(s):  
Rural Areas ◽  
Clinical Characteristics ◽  
Pediatric Patients ◽  
Age Of Onset ◽  
Age Groups ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Enzyme Linked Immunosorbent Assay ◽  
Ocular Toxocariasis

Objective: The aim of the study was to analyze the clinical characteristics of pediatric patients with ocular toxocariasis. Methods: Ocular toxocariasis was diagnosed and treated in 46 children from Shanghai and surrounding provinces. The diagnosis of ocular toxocariasis was confirmed immunologically by performing an enzyme-linked immunosorbent assay on serum and/or intraocular fluid. All pediatric patients and their guardians completed a questionnaire concerning their cases and living habits. Results: The mean age of onset was 6 ± 3 years. Most children (85%) resided in rural areas, and 91% of the children had contact with adult dogs or puppies. At the first visit, visual acuity (VA) was <20/200 in 36 cases, and we detected peripheral granuloma in 36 patients. In our study, the most common signs were vitritis, vitreous strands, and tractional retinal detachment. The Optomap 200Tx device detected granuloma with an 85% sensitivity, which is much higher than that of other techniques. We treated 40 cases (87%) with topical corticosteroids, while 28 patients (61%) were treated with systemic corticosteroids. Only 18 children (39%) required surgical intervention. All patients were examined and treated by the same ophthalmologists. Conclusions: Preschool children in China are more often affected by toxocariasis compared with other age groups. The most common signs included unilateral granuloma and ocular inflammation. In our study, clinical manifestations were severe and complicated. At the first visit, VA was <20/200 in most patients. Ocular toxocariasis was diagnosed on the basis of clinical signs and symptoms; the diagnosis was confirmed by immunological testing. Techniques using the Optomap 200Tx device can facilitate the early detection and lead to better visual prognosis.

scholarly journals CHILDREN IN CORONAVIRUSES’ WONDERLAND: WHAT CLINICIANS NEED TO KNOW

2020 ◽  
Vol 12 (1) ◽  
pp. e2020042
Author(s):  
Giuseppe Lassandro ◽  
Valentina  Palladino ◽  
Anna Amoruso ◽  
Viviana Palmieri ◽  
Giovanna Russo ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Multiorgan Failure ◽  
Clinical Manifestations ◽  
Severe Pneumonia ◽  
Signs And Symptoms ◽  
Upper Respiratory Tract ◽  
Respiratory Tract Illnesses ◽  
Life Threatening ◽  
Human Coronaviruses ◽  
Coronavirus Infections

Human coronaviruses (HCoVs) commonly cause mild upper-respiratory tract illnesses but can lead to more severe and diffusive diseases. A variety of signs and symptoms may be present, and infections can range in severity from common cold and sore throat to more serious laryngeal or tracheal infections, bronchitis, and pneumonia. Among the seven coronaviruses that affect humans, (SARS)-CoV, the Middle East respiratory syndrome (MERS)-CoV and the most recent coronavirus disease 2019 (COVID-19) represent potential life-threatening diseases worldwide. In adults they may cause severe pneumonia that evolve in distress respiratory syndrome and multiorgan failure with a high mortality rate. Children appear to be less susceptible to develop severe clinical disease and present usually with mild and aspecific symptoms similar to other respiratory infections typical of childhood. However, some children such as infants, adolescents or those with underlying diseases may be more at-risk categories and require greater caution from clinicians. Available data on pediatric coronavirus infections are rare and scattered in the literature. The purpose of this review is to provide to clinicians a complete and updated panel useful to recognize and characterize the broad spectrum of clinical manifestations of coronavirus infections in the pediatric age.

scholarly journals Characteristics of the pediatric patients diagnosed with SARS-CoV-2 infection in a Romanian children’s hospital: a retrospective study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11560
Author(s):  
Liana-Cătălina Gavriliu ◽  
Carmen Murariu ◽  
Vladimir Potop ◽  
Radu Spătaru
Keyword(s):  
Pediatric Patients ◽  
Age Distribution ◽  
Asymptomatic Group ◽  
Children's Hospital ◽  
Asymptomatic Patients ◽  
Moderate Disease ◽  
Children’S Hospital ◽  
Risk Patients ◽  
Chest X Ray ◽  
Epidemiological Characteristics

Background To date, information on COVID-19 pediatric patients is still sparse. We aimed to highlight the epidemiological and clinical data regarding SARS-CoV-2 infection in children and adolescents to improve the understanding of the disease in this age group and inform physicians during the ongoing COVID-19 pandemic. Methods We conducted a retrospective, observational study in “Marie Curie” Emergency Children’s Hospital from Bucharest, Romania. We analyzed clinical and epidemiological characteristics of the patients confirmed with SARS-CoV-2 infection, between April 1, 2020–October 31, 2020. Results A total of 172 patients aged 0–18 years were included, 79 (45.93%) female and 93 (54.07%) male patients. 28 (16.28%) patients had co-morbidities (more often identified in asymptomatic group; p < 0.0001). 47 (27.32%) had exposure to an identified source. 30 (17.44%) patients were asymptomatic; 142 (85.56%) had mild or moderate disease. The most frequent symptoms were: pyrexia (78.87%), digestive symptoms (50%), cough (40.14%). Chest X-ray was performed in 50 patients and it was abnormal in half of them, all being symptomatic. About 2/3 of the evaluated patients had normal leukocytes. The most common hematological change was lymphopenia; monocytes tended to be higher in symptomatic patients. About 40% of the patients were admitted; none required admission to ICU. No significant differences were found between symptomatic and asymptomatic patients regarding gender, age distribution, and exposure to a source. Conclusions All the patients had asymptomatic, mild or moderate disease. Patients with comorbidities, classically considered high risk patients, presented the same pattern of disease.

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